Evaluation of surgical performance during laparoscopic incisional hernia repair: A multicenter study

Iman Ghaderi, Marilou Vaillancourt, Gideon Sroka, Pepa A. Kaneva, Melina C. Vassiliou, Ian Choy, Allan Okrainec, F. Jacob Seagull, Erica Sutton, Ivan George, Adrian Park, Rita Brintzenhoff, Dimitrios Stefanidis, Gerald M. Fried, Liane S. Feldman

Research output: Contribution to journalArticle

Abstract

Background: Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity. Methods: The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed by experts to evaluate the steps of LIHR (placement of trocars, adhesiolysis, estimation of mesh size and shape, mesh orientation and positioning, mesh fixation, knowledge and autonomy in use of instruments, overall competence), each rated on a 5-point Likert scale. During LIHR, 13 attending surgeons and fellows experienced in minimally invasive surgery (MIS) and 19 novice surgeons (postgraduate years [PGYs], 3-5) were evaluated at four teaching hospitals by the attending surgeon, a trained observer, and self-assessment using GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), and internal consistency of rating items was assessed by Cronbach's alpha. Known-groups construct validity was assessed by using the t-test and by correlating of the number of self-reported LIHR cases with the total score. Concurrent validity was assessed by correlating the GOALS-IH score with the GOALS general rating scale. Data are presented as mean and 95% confidence interval (CI). Results: Interrater reliability for the total GOALS-IH score was 0.79 (95% CI, 0.60-0.89) between observers and attending surgeons, 0.81 (95% CI, 0.58-0.92) between participants and attending surgeons, and 0.89 (95% CI, 0.76-0.96) between participants and observers. Internal consistency was high (Cronbach's alpha, 0.93). Experienced surgeons performed significantly better than novices as assessed by GOALS-IH (31; 95% CI, 29-33 vs. 21; 95% CI, 19-24; p < 0.01). Very good correlation was found between GOALS-IH and previous LIHR experience (r = 0.82; p < 0.01) and strong correlation between GOALS-IH and generic GOALS total scores (r = 0.90; p < 0.01). Conclusion: Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.

Original languageEnglish (US)
Pages (from-to)2555-2563
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume25
Issue number8
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

Fingerprint

Herniorrhaphy
Multicenter Studies
Confidence Intervals
Incisional Hernia
Reproducibility of Results
Minimally Invasive Surgical Procedures
Surgeons
Surgical Instruments
Teaching Hospitals
Mental Competency

Keywords

  • Incisional hernia repair
  • Laparoscopic
  • Performance assessment
  • Rating scale

ASJC Scopus subject areas

  • Surgery

Cite this

Ghaderi, I., Vaillancourt, M., Sroka, G., Kaneva, P. A., Vassiliou, M. C., Choy, I., ... Feldman, L. S. (2011). Evaluation of surgical performance during laparoscopic incisional hernia repair: A multicenter study. Surgical Endoscopy and Other Interventional Techniques, 25(8), 2555-2563. https://doi.org/10.1007/s00464-011-1586-4

Evaluation of surgical performance during laparoscopic incisional hernia repair : A multicenter study. / Ghaderi, Iman; Vaillancourt, Marilou; Sroka, Gideon; Kaneva, Pepa A.; Vassiliou, Melina C.; Choy, Ian; Okrainec, Allan; Jacob Seagull, F.; Sutton, Erica; George, Ivan; Park, Adrian; Brintzenhoff, Rita; Stefanidis, Dimitrios; Fried, Gerald M.; Feldman, Liane S.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 25, No. 8, 01.08.2011, p. 2555-2563.

Research output: Contribution to journalArticle

Ghaderi, I, Vaillancourt, M, Sroka, G, Kaneva, PA, Vassiliou, MC, Choy, I, Okrainec, A, Jacob Seagull, F, Sutton, E, George, I, Park, A, Brintzenhoff, R, Stefanidis, D, Fried, GM & Feldman, LS 2011, 'Evaluation of surgical performance during laparoscopic incisional hernia repair: A multicenter study', Surgical Endoscopy and Other Interventional Techniques, vol. 25, no. 8, pp. 2555-2563. https://doi.org/10.1007/s00464-011-1586-4
Ghaderi, Iman ; Vaillancourt, Marilou ; Sroka, Gideon ; Kaneva, Pepa A. ; Vassiliou, Melina C. ; Choy, Ian ; Okrainec, Allan ; Jacob Seagull, F. ; Sutton, Erica ; George, Ivan ; Park, Adrian ; Brintzenhoff, Rita ; Stefanidis, Dimitrios ; Fried, Gerald M. ; Feldman, Liane S. / Evaluation of surgical performance during laparoscopic incisional hernia repair : A multicenter study. In: Surgical Endoscopy and Other Interventional Techniques. 2011 ; Vol. 25, No. 8. pp. 2555-2563.
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abstract = "Background: Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity. Methods: The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed by experts to evaluate the steps of LIHR (placement of trocars, adhesiolysis, estimation of mesh size and shape, mesh orientation and positioning, mesh fixation, knowledge and autonomy in use of instruments, overall competence), each rated on a 5-point Likert scale. During LIHR, 13 attending surgeons and fellows experienced in minimally invasive surgery (MIS) and 19 novice surgeons (postgraduate years [PGYs], 3-5) were evaluated at four teaching hospitals by the attending surgeon, a trained observer, and self-assessment using GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), and internal consistency of rating items was assessed by Cronbach's alpha. Known-groups construct validity was assessed by using the t-test and by correlating of the number of self-reported LIHR cases with the total score. Concurrent validity was assessed by correlating the GOALS-IH score with the GOALS general rating scale. Data are presented as mean and 95{\%} confidence interval (CI). Results: Interrater reliability for the total GOALS-IH score was 0.79 (95{\%} CI, 0.60-0.89) between observers and attending surgeons, 0.81 (95{\%} CI, 0.58-0.92) between participants and attending surgeons, and 0.89 (95{\%} CI, 0.76-0.96) between participants and observers. Internal consistency was high (Cronbach's alpha, 0.93). Experienced surgeons performed significantly better than novices as assessed by GOALS-IH (31; 95{\%} CI, 29-33 vs. 21; 95{\%} CI, 19-24; p < 0.01). Very good correlation was found between GOALS-IH and previous LIHR experience (r = 0.82; p < 0.01) and strong correlation between GOALS-IH and generic GOALS total scores (r = 0.90; p < 0.01). Conclusion: Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.",
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author = "Iman Ghaderi and Marilou Vaillancourt and Gideon Sroka and Kaneva, {Pepa A.} and Vassiliou, {Melina C.} and Ian Choy and Allan Okrainec and {Jacob Seagull}, F. and Erica Sutton and Ivan George and Adrian Park and Rita Brintzenhoff and Dimitrios Stefanidis and Fried, {Gerald M.} and Feldman, {Liane S.}",
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T2 - A multicenter study

AU - Ghaderi, Iman

AU - Vaillancourt, Marilou

AU - Sroka, Gideon

AU - Kaneva, Pepa A.

AU - Vassiliou, Melina C.

AU - Choy, Ian

AU - Okrainec, Allan

AU - Jacob Seagull, F.

AU - Sutton, Erica

AU - George, Ivan

AU - Park, Adrian

AU - Brintzenhoff, Rita

AU - Stefanidis, Dimitrios

AU - Fried, Gerald M.

AU - Feldman, Liane S.

PY - 2011/8/1

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N2 - Background: Laparoscopic incisional hernia repair (LIHR) is a common procedure requiring advanced laparoscopic skills. This study aimed to develop a procedure-specific tool to assess the performance of LIHR and to evaluate its reliability and validity. Methods: The Global Operative Assessment of Laparoscopic Skills-Incisional Hernia (GOALS-IH) is a 7-item global rating scale developed by experts to evaluate the steps of LIHR (placement of trocars, adhesiolysis, estimation of mesh size and shape, mesh orientation and positioning, mesh fixation, knowledge and autonomy in use of instruments, overall competence), each rated on a 5-point Likert scale. During LIHR, 13 attending surgeons and fellows experienced in minimally invasive surgery (MIS) and 19 novice surgeons (postgraduate years [PGYs], 3-5) were evaluated at four teaching hospitals by the attending surgeon, a trained observer, and self-assessment using GOALS-IH, and by a previously validated 5-item general laparoscopic rating scale (GOALS). Interrater reliability was assessed by intraclass correlation (ICC), and internal consistency of rating items was assessed by Cronbach's alpha. Known-groups construct validity was assessed by using the t-test and by correlating of the number of self-reported LIHR cases with the total score. Concurrent validity was assessed by correlating the GOALS-IH score with the GOALS general rating scale. Data are presented as mean and 95% confidence interval (CI). Results: Interrater reliability for the total GOALS-IH score was 0.79 (95% CI, 0.60-0.89) between observers and attending surgeons, 0.81 (95% CI, 0.58-0.92) between participants and attending surgeons, and 0.89 (95% CI, 0.76-0.96) between participants and observers. Internal consistency was high (Cronbach's alpha, 0.93). Experienced surgeons performed significantly better than novices as assessed by GOALS-IH (31; 95% CI, 29-33 vs. 21; 95% CI, 19-24; p < 0.01). Very good correlation was found between GOALS-IH and previous LIHR experience (r = 0.82; p < 0.01) and strong correlation between GOALS-IH and generic GOALS total scores (r = 0.90; p < 0.01). Conclusion: Surgical performance during clinical LIHR can be assessed reliably using GOALS-IH. Results can be used to provide formative feedback to the surgeon and to identify steps of the operation that would benefit from specific educational interventions.

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KW - Laparoscopic

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